Focal Hepatic Lesions

Question 1

What are features of hepatocellular carcinoma (HCC)?

Answer 1

• 3^rd most common cause of cancer worldwide
• Chronic hep B is most common cause of HCC worldwide
• Chronic hep C most common cause in Europe

Question 2

The biggest risk factor for developing HCC is liver cirrhosis, for example, secondary to Hep B and C, alcohol, haemochromatosis and primary biliary cirrhosis.

What are other risk factors for HCC?

Answer 2

• a-1 antitrypsin deficiency
• Hereditary tyrosinosis
• Glycogen storage disease
• Aflatoxin
• Drugs → COCP, anabolic steroids
• Porphyria cutanea tarda
• Male sex
• Diabetes mellitus, metabolic syndrome

Question 3

What is the clinical presentation of HCC?

Answer 3

• Presents late
• Features of liver cirrhosis or failure may be seen → jaundice / ascites / RUQ pain / hepatomegaly / pruritus / splenomegaly
• Possible presentation is decompensation in a patient w/ chronic liver disease
• Raised AFP

Question 4

What is the screening for HCC?

Answer 4

• Ultrasound
• +/- alpha-fetoprotein

Question 5

Who is screening reserved for?

Answer 5

High risk groups

• Pts w/ liver cirrhosis secondary to hep B and C or haemochromatosis
• Men w/ liver cirrhosis secondary to alcohol

Question 6

What are management options for HCC?

Answer 6

• Early disease → surgical resection
• Liver transplantation
• Radiofrequency ablation
• Transaterial chemoembolism
• Sorafenib (multikinase inhibitor)